January 09, 2014

WHO has been informed of an additional laboratory-confirmed case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in Oman.

The case is a 59 year-old man who became sick with fever, cough and shortness of breath on 20 December 2013 and was admitted to hospital in North Batinha Governorate on 24 December. On 28 December his condition deteriorated and he was transferred to an intensive care unit and was diagnosed with pneumonia. The patient died on 30 December. A laboratory confirmation of MERS-CoV was made on 1 January 2014.

The patient had a history of daily exposure to camels and other farm animals and also participated in camel race events. In addition, the man was a heavy smoker.

Globally, from September 2012 to date, WHO has been informed of a total of 178 laboratory-confirmed cases of infection with MERS-CoV, including 75 deaths.

On 8 January 2014, Canada reported a fatal imported case of influenza A(H5N1) infection. This is the first confirmed human case of H5N1 in North America.

The onset of symptoms began on 27 December 2013 during a return flight from Beijing to Edmonton via Vancouver. The symptoms worsened during the travel and the patient was admitted to hospital on arrival in Edmonton, and passed away on 3 January 2014. The clinical presentation, fever, malaise and headache, was consistent with meningo-encephalitis and did not involve the respiratory system which is unusual for A(H5N1) infection. Tests at a reference laboratory confirmed influenza A(H5N1) infection on 7 January. The case had not been outside of Beijing during the visit trip to China and had not visited live bird markets or farms.

The Public Health Agency of Canada is following up two family contacts who travelled together with the patient.

Risk of secondary cases considered very low

Worldwide since 2003, less than 650 human cases of A(H5N1), including 384 deaths, have been reported from 15 countries. No autochthonous or imported cases of A(H5N1) infections have been reported in Europe since 1996, when this strain was first detected. Most have been exposed to infected birds. In 2013, China reported 2 fatal cases of A(H5N1), and the last case was reported in February 2013.

The risk of secondary and co-primary cases among the close contacts of this case is considered to be very low for the following reasons: more than 10 days has passed since the onset of disease, transmission of A(H5N1) on board aircrafts has never been documented, and there is no evidence of sustained human-to-human transmission of A(H5N1) ever occurring. The risk of health care associated transmission in Canada is considered very low for the same reasons.

The evidence points to an isolated case who was infected following exposure in China, although the source and mode of transmission has not yet been established. A(H5N1) is a strain of avian influenza that occasionally crosses the species barrier and infects humans. Sporadic cases originating in areas where A(H5N1) transmission has been documented in the recent past are therefore not unexpected.

Although the case reported from Canada had an atypical clinical presentation and an exposure to potentially infected birds has not been established, these circumstances do not change the conclusions in the latest ECDC Risk Assessment of 12 January 2012.

ECDC concurs with the recommendations made by the Canadian Public Health Agency which are in line with the ECDC recommendations that Europeans travelling to China and South-East Asia should avoid live poultry markets and any contact with chickens, ducks, wild birds, and their droppings. This reduces the risk of exposure not only to A(H5N1) but also to A(H7N9). Poultry meat and eggs should be well cooked.

In the 19th century, there were several major cholera pandemics in the Indian subcontinent, Europe, and North America. The causes of these outbreaks and the genomic strain identities remain a mystery.

We used targeted high-throughput sequencing to reconstruct the Vibrio cholerae genome from the preserved intestine of a victim of the 1849 cholera outbreak in Philadelphia, part of the second cholera pandemic. This O1 biotype strain has 95 to 97% similarity with the classical O395 genome, differing by 203 single-nucleotide polymorphisms (SNPs), lacking three genomic islands, and probably having one or more tandem cholera toxin prophage (CTX) arrays, which potentially affected its virulence.

This result highlights archived medical remains as a potential resource for investigations into the genomic origins of past pandemics.

An Albertan has become the first person in North America to die from the rare H5N1 virus, also known as avian or bird flu.

The victim died on Jan. 3, about a week after returning from a trip to China to visit family, the Public Health Agency of Canada announced Wednesday.

Dr. James Talbot, Alberta’s chief medical officer of health, said he is confident the virus will not spread. The victim’s family is showing no symptoms and the bird flu virus, unlike other types of flu, is extremely difficult to pass from human to human.

Talbot declined to provide any details about the patient’s identity, including age, gender or hometown, though he said the victim began experiencing symptoms of “fever, malaise and headache” on Dec. 27 flights from Beijing to Vancouver and Vancouver to Edmonton.

He said the victim, who does not live in Edmonton, checked into an undisclosed hospital Jan. 1 and died two days later in an intensive care unit.

“One of the unusual features of this case was that at no time did they have a cough or respiratory type symptoms. For some H5N1s, that is a typical course and they tend to deteriorate pretty rapidly,” Talbot said.

“The diagnosis at time of death was meningoencephalitis, which is an inflammation of the brain and linings that cover the brain. That is one of the ways H5N1 patients die.”

Specimens sent to a provincial lab were found on Sunday to be negative for the more common H3N2 and H1N1 flu strains now circulating in Alberta. The National Microbiology Laboratory in Winnipeg then became involved, confirming Tuesday the existence of North America’s first case of H5N1.

Talbot said Alberta health officials initiated a “close contact followup” immediately after learning that the victim had developed a serious illness in China. Everyone who had been in contact with the deceased was monitored closely for symptoms and offered the antiviral drug Tamiflu.

Health workers wore protective clothing and gloves while treating the victim, he said.

“As a consequence of the fact it is very rare to see transmission and that we took extra precautions and no one is symptomatic, I am confident there will be no transmission within the province of Alberta,” Talbot said.

“In the middle of the H1N1 season, it would have been easy to write this off as an unfortunate consequence of the H1N1 (outbreak), but because of our vigilance we were able to (handle) this in what I think is a textbook manner.”

In a related report, the Journalreports that Alberta expects to run out of seasonal flu vaccine by Friday.

Following confirmation of measles cases among children in several camps for internally displaced people in Bangui, Central African Republic, Doctors Without Borders/Médecins Sans Frontières (MSF) is vaccinating 68,000 children in five camps in the city in order to prevent an outbreak.

Hundreds of thousands of people are currently displaced in camps around Bangui as a result of widespread violence that began early December.

MSF has already vaccinated more than 25,000 children in the Don Bosco and Boy Rabe camps and plans to have vaccinated 40,000 children in Mpoko camp and 3,000 in the Saint Michel and Saint Elime camps by Friday, January 10.

All children between six months and 15 years of age are being targeted, which accounts for 40 percent of the total camp population. MSF also screens children under five years old for malnutrition and treats the severe cases. Complicated cases are referred to a specialized center.

“Measles can be a very deadly disease for children and is highly contagious,” said MSF’s vaccination coordinator Tessy Fautsch. “Ten to thirty percent of those children with already-low natural immunity do not survive, unless they are vaccinated. As many of the children in the camps are weak and living in deplorable conditions, we absolutely want to prevent an epidemic, which is why we are carrying out these vaccinations.”

Although the risk of seeing additional avian flu cases in Canada (or the United States) as a result of yesterday’s announced H5N1 fatality in Alberta, Canada is considered low, the CDC released the following lengthy and informative statement last night on this case, including a good deal of background on avian flu viruses.

A new human case of H7N9 bird flu was reported in east China's Zhejiang Province on Thursday, the provincial health and family planning commission said in a statement.

The patient is a 51-year-old woman, surnamed Shen, who is from the city of Tongxiang. She was confirmed to be infected with the virus on Wednesday and is in critical condition at a hospital in the provincial capital of Hangzhou, according to the statement.

This is the second case reported in Zhejiang in 2014. Human cases of H7N9 have been reported in the provinces of Zhejiang, Jiangsu and Guangdong so far this year.

Food and Health Secretary Dr Ko Wing-man on Thursday did not out the possibility that more Hongkongers might be have the deadly H7N9 virus after a Hong Kong patient came down with the avian flu following a mainland trip.

The patient, a 66-year-old man with no history of consuming or coming in contact with live poultry, was diagnosed with bird flu after “passing by” a wet market in Shenzhen.

The man, who is in critical condition, is in isolation and getting intensive treatment at Queen Mary Hospital in Pok Fu Lam. “In the past, the virus has been detected in many samples taken from the environment. It means people should be careful when visiting wet markets, especially where live poultry is on sale,” Ko said. “The risk for people who suffer from chronic illness to visit the wet market is also higher.”

Ko noted that the patient with H7N9 was already suffering from long-term illness and required regular hemodialysis, a process for cleansing the blood of toxins.

Ko said experts have warned that the virus could be more active in winter, and believed more cases would emerge around Guangdong province and other southern Chinese regions.

January 08, 2014

At least 17 children in a private kindergarten in east China's Hangzhou City have developed an unexplained condition under which their fingernails have fallen off, according to the school and local health departments.

Li Yuefang, head of the Wenshou Kindergarten, said on Thursday that the 17 kids began to experience the nail problems in December.

"No cause has been found," Li said, admitting that 12 students had been withdrawn from the kindergarten as their parents worried about their safety.

A post exposing the case appeared in an internet forum on Tuesday, saying over 50 children in the kindergarten have shown similar symptoms of separated nails.

The educational bureau in Xiacheng District of Hangzhou, which administrates the kindergarten, confirmed on Thursday that medical experts have ruled out the possibilities indoor environmental pollution and fungal infection.

The municipal center of disease control has entrusted a local air testing center to check the air quality in the kindergarten's classroom. All indicators have proved on par with relevant safety standards.

The Hangzhou No. 5 Hospital has also ruled out the possibility of fungal infection for five of the 17 kids whose symptoms are more severe than others.

This Wednesday afternoon, President Sebastián Piñera met with the minister of health, Jaime Mañalich, to analyze the situation affecting several regions because of forest fires. They pose a threat to air quality and public health.

After the meeting, the chief of state said "We've had to confront over 70 forest fires recently. Some are extinguished, others are controlled and under observation, and some are in full development. The situation has been especially serious in Valparaíso Region, the Metropolitan Region, Maule Region, and La Araucanía Region.

President Piñera said, "Since the environmental authority in summer months doesn't have enough resources to control and improve the air quality, we think it's necessary that the Ministry of Health assume the responsibility." For that reason it was decided to decree a Preventive Health Alert for Valparaíso, the Metropolitan Region, Maule, and La Auraucanía.

The president said it's a "signal of calm" for the public, adding that factors taken into account include the number of fires, the increase of rats and other rodents, and the demand on hospitals. He went on to say the preventive alert will grant "more instruments and resources so the Ministry of Health can fulfil its preventive role and prepare itself to confront the situation."